Results Worksheet

CDC Model Performance Evaluation Program (MPEP) for Mycobacterium tuberculosis Drug Susceptibility Testing

Attachment 7

M. tuberculosis Results Worksheet

MPEP Mycobacterium tuberculosis Results Worksheet

Public reporting burden of this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-0600)

Enter your drug susceptibility test results for each isolate by using the data worksheets below. There are separate worksheets for conventional drug susceptibility results and molecular test results. These worksheets are provided as a tool for recording results prior to online data entry.

Conventional Drug Susceptibility Worksheet: Isolate       Method                     

Drug	Resistant	Susceptible	Borderline	Contaminated	No Growth	Not Done
Rifampin
Isoniazid - low level
Isoniazid - high level
Ethambutol
Pyrazinamide
Streptomycin
Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-Amino Salicyclic Acid

Molecular Results Worksheet: Isolate       Method                     

Drug	Mutation Detected	Mutation Not Detected	No Result	Not Done
Rifampin
Isoniazid
Ethambutol
Pyrazinamide
Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide